IN THE CIRCUIT COURT OF THE EIGHTH JUDICIAL CIRCUIT IN AND FOR ________________ COUNTY, FLORIDA IN RE: GUARDIANSHIP OF ________________________________ CASE NO. ___________________ GUARDIANSHIP DIVISION APPLICATION FOR APPOINTMENT AS GUARDIAN / GUARDIAN ADVOCATE Pursuant to Florida Guardianship Law, the undersigned submits this Application for Appointment as Guardian/Guardian Advocate of _________________and submits the following information: 1. Name: [name of applicant]. 2. Age: [number of years]. 3. Residence Address: [address of applicant]. 4. Mailing Address, E-mail address, Telephone Number: 5. U.S. Citizen? Circle Yes No 6. Employer's Name and Address: [name of employer], [address of employer]. American LegalNet, Inc. www.FormsWorkFlow.com Applicant's Position: [title of applicant]. 7. Home Telephone Number: [home phone number of applicant]. Work Telephone Number: [work phone number of applicant]. CIRCLE [EITHER:] 8. Applicant is not currently serving as guardian or guardian advocate for any other ward. [OR:] Applicant is currently serving as guardian or guardian advocate for: [names of wards],[court file numbers for each guardianship]. Applicant is acting as the limited guardian plenary guardian, guardian advocate of the person, guardian advocate of the property, guardian advocate of both the person and the property. 9. Does applicant have any physical disabilities? Yes No [description of disability]. 10. Has applicant ever been treated for the following: a. b. c. Mental Condition Alcohol Drugs Yes Yes Yes No No No American LegalNet, Inc. www.FormsWorkFlow.com d. Other Yes No [Description of nature of condition and summary of treatment]. 11. Has applicant ever been judicially determined to have committed abuse or neglect against a child as defined by the Florida Statutes? Yes No 12. Has applicant ever been the subject of a confirmed report of abuse, neglect, or exploitation which has been uncontested or upheld pursuant to the provisions of Sections 415.104 and 415.1075, Florida Statutes? Yes No 13. Has applicant ever been charged with fraud, misrepresentation or perjury in a judicial or administrative proceeding? Yes No [Description of incident and proceeding]. 14. Has applicant ever been charged with, arrested for or convicted of a felony? Yes No [Description of offense and final disposition]. 15. Has applicant ever been charged with, arrested for or convicted of any other crimes? Yes No [Description of offense and final disposition]. American LegalNet, Inc. www.FormsWorkFlow.com 16. Has applicant ever held a position which required bonding? Yes No [Description of position]. 17. Has applicant, in the past, ever served as guardian / guardian advocate of a person or of a person's property? Yes No [Description of service]. 18. Has applicant ever been held in contempt of court or removed as a guardian / guardian advocate? Yes No [Description of details]. 19. Has applicant ever filed for bankruptcy? Yes No [Statement of date and location of court]. 20. What is applicant's relationship with the person with a developmental disability? [Description of relationship]. 21. Is applicant, or applicant's business, corporation, or other business entity a creditor of, or providing professional, personal or business services to the person with a developmental disability? Yes No [Statement of details]. 22. Is applicant employed by a business, corporation, or other business entity which is providing professional, personal or business service to the person with a developmental disability? Yes No American LegalNet, Inc. www.FormsWorkFlow.com [Statement of details]. 23. Is applicant a health care provider for the person with a developmental disability? Yes No 24. Educational history of applicant: High school: [name of high school], [address of high school]; [title of degree]; [date of completion]. College: [name of college], [address of college]; [title of degree]; [date of completion]. Other: [name of other institution], [address of other institution]; [title of degree]; [date of completion]. 25. List applicant's employment experience for the past ten (10) years beginning with the most recent date: [Specification of employment experience]. American LegalNet, Inc. www.FormsWorkFlow.com 26. Has applicant ever been discharged from employment by any employer listed above? Yes No [Explanation of circumstances]. 27. Does applicant possess any special educational qualifications (financial, business or otherwise) that uniquely qualifies applicant to be appointed as guardian / guardian advocate? Yes No [Description of qualifications]. 28. Has applicant received instruction and training which covered the legal duties and responsibilities of guardian / guardian advocate, the rights of an incapacitated person or Ward, the availability of local resources to aid a Ward, and the preparation of habitual plans and annual guardian reports, including financial accounting for the ward's property? Yes No [Statement of training]. I understand that I will be required to take the Guardianship Education Class, which is offered through the Eighth Judicial Circuit Bar Association, and will file the Certificate of Completion with the Court. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Date: ______________________________ Applicant American LegalNet, Inc. www.FormsWorkFlow.com